Hi Victoria,Sorry to hear about your sleep problem. There are sleep centers which specialize in sleep disorders. They will evaluate you from all angles to figure out the cause and try to treat the root cause of the problem which will help you get a good night of sleep. Without good REM sleep (deep sleep) you will not feel refreshed in the morning. Instead of just recommending a treatments that I offer, I hear your pain and would like to try to help you. Also, I want to add my insights about the procedures that we (RS providers) all offer, to avoid any future problems which could possibly occur.Why Do We Look Tired, When We Are Tired?When people are not well rested or pulled an all nighter for an example, we will look bad with dark circles and a bit drained, pale and maybe even a bit gaunt, like a vampire just drank some of our blood. After pulling an all nighter for an exam, the student (young person who really should not need any cosmetic facial injections or fat grafting) may crash and sleep until 2pm and wake up with their face looking puffy. The reason the same person looks tired, then puffy is related to their sleeping by probably due to laying supine or flat for 8-10 hours in this case 12-14 hours. If you are standing or sitting up for too long, all of the fluid on your face and neck area will drain down towards your feet over the full day, until you go to sleep again. If a person pulls an all-nighter for an exam, they will have been upright for nearly 24 hours without sleep and when they head to the exam they will look tired with dark circles. You should see how bad residents (training doctors) and medical students look after being on-call overnight.When laying down to sleep at night, the fluid that has pooled down to your feet will then start to redistribute evenly back to your face and neck area and less fluid build up on your feet. That is also why peoples' feet feel tired and swollen at the end of the day and should put their feet up.Too Much Smartphone Use at Night Instead of Sleeping.If you can't sleep at night you should at least try to stay laying on your back instead of getting up and using your smartphone. I also find myself doing this at night, and I suspect many people may want to check something right before bed think of something they want to look up. Before they know it, hours have past surfing the web, social media, or watching youtube, and many good hours of sleep have been wasted. Additionally, now our brains are overly-excited which makes it even harder to sleep for the rest of the night. There are many articles recently talking about trying to trying to use their smartphone less. Apple as a company also feels some responsibility that they need to curb the Smartphone Addiction which they may have helped to start. Charging their phones in a different room instead of at arms reach on the nightstand. Trying not to use the phone 1 hour before bedtime to calm the mind in preparation for sleep. Meditating or trying to clear your mind may also help.Treating the Symptom or Treating the Illness.Although fillers and fat grafting will volumize the diagonal tear trough grooved under the eyes, my approach is more holistic. Assuming you did not have any the lower eyelid problem prior to 5 months ago, then the newly formed tear trough grooves are actually a "symptom" of your problem or "illness" of not being about to sleep for 5 months.Treating the tear trough "symptom" first without treating the root problem which is the insomnia seems premature and is not treating the whole person. I use this analogy in my consultations. If a person has a cough, that person can go to the pharmacy and get cough syrup to suppress the cough. This will help the cough (the symptom), but if the patient actually has a cough from asthma, pneumonia, bronchitis, or god forbid a small tumor in their lungs, wouldn't it make more sense to get the cough checked out and treated.So in this analogy, instead of using cough syrup every 4-6 hours to suppress the cough, we ask more questions and find out that the person is also getting fevers and chills, and it hurts to take a deep breath. A primary care doctor listens to their lungs and hear crackles and decreased breath sounds on the left lower part of the back. An x-ray is ordered to find out that there is a pneumonia and the person is placed on antibiotics. The cough improves while on the antibiotics without using cough syrup. When Do I Recommend Treating Lower Eyelid Hollowness, Dark Circles or Eyebags?The patients who I do feel are good candidates for tear trough filling with hyaluronic acid fillers, tell me that they sleep great and feel energized, but their dark circles send a different message. Others may have this problem genetically since they were young, and feel fine from a sleep and tiredness standpoint. These patients are getting the facial/eyelid treatments to help them look more rested and energized which is how they actually feel. Once you are getting better sleep and get back to being your normal self, if you still have some residual tear troughs which bothers you, then it would be reasonable to consider a treatment.Fat Grafting vs. Hyaluronic Acid FillersI think the huge majority of the Realself providers would use HA fillers over fat grafting. I have no doubt that the surgeons who say that they are very proficient with fat grafting can get good results, but can they control what the fat graft will do in the future? It may only take 5-10 minutes to inject fat into the tear trough area, but would it be so easy to remove the fat if it somehow grows in the future. If the patient hollows even more over time with age, will the fat somehow be smart enough to grow also to fill in the additional fat loss? or might there be gaps between the fat graft and the additional hollowing of the eyes. I have seen upper and lower eyelid filling results in my practice which have lasted beyond 5 years with a single treatment. I tell my patients to expect 18-24 months before considering any touch ups, but most wait longer than that. UPOD- under-promise/over-deliver. The main issue I do see is the Tyndall effect in older patients with very thin lower eyelid skin. I have not seen any Tyndall effect on the upper eyelid/brow area. Younger patients have thicker skin naturally with more fat, so they do better than the older patients. The fat survival averages 30% but can range from 10-50%. Filler volumes are accurate to the fraction of a milliliter. Even with my own filling of the upper and lower eyelid areas, I like to follow up with the patient to make sure it looks smooth and it looks good whether they are looking straight, up, down, or smiling without any weird bulges. The filler can be rolled smooth or reduced or dissolved, but the fat graft will scar into place and cannot be molded, and not easily reduced or reversed.Best,
